Handbook for Death Scene Investigators Jay Dix, M.D. Medical Examiner Boone County, Missouri and Associate Professor of Pathology Department of Pathology University of Missouri with Mary Fran Ernst, B.S. Medicolegal Investigator St. Louis County, Missouri and Assistant Professor of Pathology Director of Medicolegal Education Department of Pathology St. Louis University, Missouri ©1999 CRC Press LLC Library of Congress Cataloging-in-Publication Data Catalog record is available from the Library of Congress This book contains information obtained from authentic and highly regarded sources. Reprinted material is quoted with permission, and sources are indicated. A wide variety of references are listed. Reasonable efforts have been made to publish reliable data and information, but the author and the publisher cannot assume responsibility for the validity of all materials or for the conse- quences of their use. 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Trademark Notice: Product or corporate names may be trademarks or registered trademarks, and are only used for identification and explanation, without intent to infringe. © 1999 by CRC Press LLC No claim to original U.S. Government works International Standard Book Number 0-8493-0298-6 Printed in the United States of America 1 2 3 4 5 6 7 8 9 0 Printed on acid-free paper ©1999 CRC PressLLC Contents Preface Chapter 1 Guidelinesfor the Death Scene Investigator Chapter 2 Signs of Sudden Death and Disease Chapter 3 Obtaining a Medical History Chapter 4 Traumatic Deaths Chapter 5 Time of Death and Decomposition Chapter 6 Decedent Identification Chapter 7 Scene Evidence Collection Chapter 8 Signs of CPR andTreatment Chapter 9 TheAutopsy Chapter 10 Other ExpertsWho May Be Needed Chapter 11 Cause, Mechanism, and Manner of Death Appendices A. MedicalTerminology B. Prescription Medicines C. Photographs ©1999 CRC PressLLC Preface In most jurisdictions, the body of a deceased individual and the death scene are the responsibilities of a medical examiner’s (or coroner’s) office and the local law enforce- ment agency. A medicolegal death investigator is a repre- sentative of the medical examiner or coroner and should be the most knowledgeable person about the cause and manner of death at the death scene. The death investiga- tor should focus on the physical condition of the body at the scene. Scene information regarding injuries, trace evi- dence, identification, and estimation of time of death should be evaluated and recorded. This information is essential to the medical examiner or coroner in order that a proper determination of cause and manner of death can be made. The importance of an investigation in any death cannot be over-emphasized. In many cases, the scene investiga- tion is more important than the autopsy. A thorough and complete investigation commonly leads to the proper diagnosis of the cause and manner of death prior to an autopsy. The medical examiner and coroner cannot per- form their duties without this vital information. Well-trained investigators are an integral part in any forensic jurisdic- tion. The importance of sound investigation will become more evident as the investigator uses this handbook. ©1999 CRC PressLLC Acknowledgments I would like to thank Dr. John Townsend, Chairman of the Department of Pathology, University of Missouri, for allow- ing me to use departmental resources to complete this project. I am indebted to Kirstie Calcutt and Ardath Cal- vert for their help with the photographs. I would also like to thank Dr. Robert Calaluce who edited some of the material used in this handbook. ©1999 CRC PressLLC 1 Guidelines for the Death Scene Investigator 1. Pre-plan the Death Investigation When initially notified of a death, the death investigator should determine as much information as possible from the caller. Approximate age and sex will enable a subject to be placed in the appropriate “medical category.” Deter- mining where the decedent has been found will be helpful in investigational planning. An attempt should be made to ascertain if there is any evidence of foul play or if any implements are available that might have played a role in the subject’s death. By gathering these pieces of death scene data, the death investigator will be able to antici- pate additional information that may be needed upon arrival at a scene. 2. Establish Telephone Contact with the Death Scene If notified by a dispatcher or another individual who is not on the scene, the investigator should attempt to contact a law enforcement officer or other official (i.e., coroner) at the death scene. By speaking directly with one of these individuals, additional information can be gained which will assist in planning necessary investigational scene activities. When speaking with this individual at the scene, a realistic expected arrival time should be provided. ©1999 CRC PressLLC 3. Notification of Personnel Transporting the Remains If possible, personally speak to the personnel who will be moving the decedent to the morgue. Explain the nature of the decedent’s condition so they can be prepared if spe- cial handling is required (e.g., decomposition, infection, etc.). This information will be appreciated and will give the personnel additional time to prepare. The investigator is the best person to determine how much time before the body can be moved. 4. Cooperation Among Investigators A successful death investigation involving more than one individual requires cooperation and coordination. Any potential conflicts should be worked out. Each office should have standard operating procedures which define the legal responsibilities for each investigating agency. Investigators from different agencies should meet prior to working scenes together so that potential areas of conflict can be discussed in an amicable and professional manner. 5. Photographs of Decedent at Death Scene Usually, an agent from law enforcement will photograph the scene. This should be done prior to disturbing the scene or the deceased. A death investigator may also take photographs (Polaroid’s are acceptable) for the forensic pathologist performing the autopsy. Information such as the location of the body and any unique circum- stances at the death scene may help the pathologist. It is important to keep in mind the legal implications of the photographs. Will the photographs be able to be subpoe- naed? Are they considered a part of the official medical examiner’s enquiry? If a death investigator suspects a ©1999 CRC PressLLC violent or suspicious death, law enforcement should be requested to take photographs. 6. Identification of the Deceased Positive identification of the decedent is crucial in all death inquiries. The family should be notified. Information such as medical history, work, and social history can only be obtained after an identification is established. Care must be taken to ensure that the identification is absolutely correct. 7. Examination of the Body A systematic and thorough inspection of the decedent should be performed by an investigator. A routine pattern of evaluation should be performed in each assessment. If an investigator always begins at the top of the subject’s body and moves toward the feet, the possibility of missing important injuries or evidence is lessened. The following should be described: 1. Any obvious injuries or abnormalities. 2. Rigor and livor mortis. 3. Body and environmental temperatures. 4. Environmental conditions such as moisture and wind. 5. Appropriateness of the clothing for type, size, and cleanliness. 6. Does it appear that the person has been redressed with buttons buttoned and zippers zipped. 7. Note all jewelry. Are any items missing? 8. Money and credit cards should be documented and returned to the legal next-of- kin. No analyses, such as gunshot residue or fingerprinting, should be performed on the decedent’s body at the scene ©1999 CRC PressLLC without the expressed consent of the forensic pathologist responsible for the postmortem examination. Clothing should not be removed. The body should not be cleansed. No liquids or powders should be placed on the deceased as these might interfere with radiographs or chemical test- ing. If more than one hour has elapsed since the initial body assessment has been made, and the decedent is still at the scene, a second assessment (to include body temperature, rigor and livor mortis) should be recorded. A thorough body visualization at the scene gives an investi- gator the capability to differentiate injuries noted at the scene from any body injuries sustained during convey- ance to the morgue. 8. Other Scene Information Collection The investigator must also gather information that relates to the cause and manner of death. Each type of death requires specific scene information. For instance, ques- tions to be asked in a motor vehicle fatality would not be the same as those asked in an autoerotic sexual asphyxial death. Since different questions need to be asked, an investigational guide for each specific type of death can be very useful. 9. Determine What Information Has Already Been Developed Prior to the investigator’s arrival, law enforcement officers, paramedics, and other support personnel have most likely already communicated with individuals or witnesses at the scene. An investigator needs to know this initial information so that he can compare initial data with the decedent’s body data and determine if there are any dis- crepancies. It is better to ask the question twice and get the same answer, than to accept as fact information that ©1999 CRC PressLLC